Provider Network Participation & Enrollment Process

Definition of Enrollment, Credentialing, and Contracting/Negotiating

Provider (Facility/Hospital)

Ancillary Services (Ambulance, Ambulatory Surgery Center, Clinic Facility, Dialysis, Durable Medical Equipment (DME), Home Health, Home Infusion, Hospice, Imaging/Radiology, Labs, Urgent Care), Hospitals (Critical Access Care, Behavioral Health (Community Mental Health Center (CMHC)), Long Term Acute Care, Long Term Care, Rehabilitation), Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), and Skilled Nursing Facilities.

Practitioner (Physician/Group)

A Medical or Behavioral Health practitioner participating in a group, RHC, or FQHC setting.

Enrollments

The process of loading a contracted and credentialed provider to all Managed Care Entity (MCE) internal systems, loading for claims payment, and loading to the provider directory (if applicable).

Credentialing

The process of reviewing the qualifications and appropriateness of a provider to join the health plan’s network. Credentialing requirements and processes will follow the National Committee for Quality Assurance (NCQA) guidelines.

Contracting/Negotiating

The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scopes of services, and so on.

Network Participation Request

A network participation request is when the provider makes a formal request to enter into a new agreement/contract with the MCE. This includes the mechanism utilized by the MCE to receive the request from the provider or group to join the MCE’s network as a contracted provider. The network participation request must include at a minimum the information/fields outlined on the Indiana Health Coverage Programs (IHCP) MCE Practitioner and IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing Forms and any supporting documentation required from providers for the MCE to enroll, credential, and initiate contracting with the provider. MCEs may not require a signed contract in order for a network participation request to be considered complete as it’s only the information necessary to begin processing the request.

Network Participation Request documents required to enroll with MHS as a Participating Provider and/or Practitioner

* Please note that all incomplete network participation requests will be rejected, and notification will be sent within 5 business days after the receipt of the initial request if the required documents are not provided.

Provider (Facility/Hospital)

The following specialty types require credentialing:

Ancillary Services (Ambulance, Ambulatory Surgery Center, Clinic Facility, Dialysis, DME, Home Health, Home Infusion, Hospice, Imaging/Radiology, Labs, Urgent Care), Hospitals (Critical Access Care, Behavioral Health (CMHC), Long Term Acute Care, Long Term Care, Rehabilitation), FQHC, RHC, and Skilled Nursing Facilities.

DMEs will be sent to our DME Escalations Team for further review.
All other Providers (Facility/Hospital)
- IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing application
- Behavioral Health Facility and Ancillary Demographic Information (if applicable)
- Valid IN License (Rehabilitation facilities and labs are not issued licenses for Indiana. Certification for a rehabilitation facility is verified with the Indiana State Department of Health. The CLIA certificate is used in lieu of a state license for laboratories.)
- Accreditation certificate (if applicable)
- Copy of Medicare certification letter
- Copy of Medicaid certification letter
- Liability coverage face sheet
- Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable)
- Drug Enforcement Agency (DEA)# (if applicable)
- Provider Location Listing
- W-9 Form

Practitioner (Physician/Group)

The following specialty types require credentialing:

All Medical or Behavioral Health practitioners participating in a group, RHC, or FQHC setting. (Internal Medicine, Surgery, Pediatrics, Neurology, Family Medicine, Orthopaedics, Ophthalmology, Dermatology, OB/GYN, Urology, Physical Therapy, Psychiatry, Neurosurgery, Oncology, ENT, Nuclear Medicine, Cardiology, Cardiothoracic Surgery, Plastic Surgery, Preventative Healthcare, Gastroenterology, Intensive Care Medicine, Nephrology, Geriatrics, General Surgery, Rheumatology, Endocrinology, Allergy and Immunology, Hematology, Colorectal Surgery, Physical Medicine and Rehabilitation, Occupational Medicine, Pulmonary, Hematology/Oncology, Vascular Surgery, Medical Genetics, Osteopathy, Sleep Medicine, Sports Medicine, Immunology, Psychology, Nurse Practitioners, Mental Health Counselor, Family and Marriage Counselor, Addiction Counselor, License Social Workers, etc.)

All other Medical Practitioner taxonomies require the below forms:
- IHCP MCE Practitioner Enrollment Form*
- Collaborative Agreement
  - Nurse Practitioner
  - Physician Assistant
  - Clinical Nurse Specialist
- Provider Credentialing Application Disability Supplement Form (New Contract Request Only)
- Provider Location Listing
- W9 Form
All Behavioral Health Practitioners taxonomies require the below forms:
- IHCP MCE Practitioner Enrollment Form*
- Behavioral Health Specialty Form
- HSPP Attestation (Psychologists Only)
- Provider Credentialing Application Disability Supplement Form (New Contract Request Only)
- Provider Location Listing
- W9 Form

*For New Contract Requests only: If you have more than 10 rendering practitioners linked to your Group NPI, instead of using the IHCP MCE Practitioner Enrollment Form, please use the MHS Enrollment Spreadsheet.

The following specialty types DO NOT require credentialing, or any forms listed above; however, you will need to fill out the required network participation request information through mhsindiana.com.

Anesthesiology, CRNA, Diagnostic Radiology, ER Physician, Pathology, and Hospital-Based Practitioners

MHS’ Credentialing Team Verification Criteria

Provider (Facility/Hospital)

The following specialty types require credentialing:

The following documents are required for credentialing as a Facility/Hospital:

IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing Application
Behavioral Health Facility and Ancillary Demographic Information (if applicable)
Valid IN License (Rehabilitation facilities and labs are not issued licenses for Indiana. Certification for a rehabilitation facility is verified with the Indiana Department of Health. The CLIA certificate is used in lieu of a state license for laboratories.)
Accreditation certificate (if applicable)
Copy of Medicare certification letter
Copy of Medicaid certification letter
Liability coverage face sheet
Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable)
Drug Enforcement Agency (DEA) # (if applicable)
W-9 form

Practitioner (Physician/Group)

The following specialty types require credentialing:

The following specialty types DO NOT require credentialing:

Anesthesiology, CRNA, Diagnostic Radiology, ER Physician, Pathology, and Hospital-Based Practitioners

The following documents are required for credentialing as a Physician/Group:

IHCP MCE Practitioner Enrollment Form
Current and complete CAQH attested within the last 120 days

The below information is required but is obtained from the IHCP MCE Practitioner Enrollment Form and the Current CAQH application:

Active Hospital Privileges or Admitting Arrangements (if applicable)
CLIA Certificate (if applicable)
Current State License
Current Board Certification (DO, MD, DPM only)
Current DEA/CSR License
Current Professional Liability Insurance
Education/Training
Sanctions History
Work History

If any information is expired or missing, the MHS Credentialing or Contracting team will outreach to request an updated version. Providers can respond via email, postal mail, or fax.

If the provider (Facility/Hospital) and/or practitioner (Physician/Group) fails to respond in the time stated on the notification, the request to enroll with MHS will be rejected and a letter and/or email will be provided.

Step by Step Guide when completing a network participation request via MHS Website

Are you a DME Provider? If so, please click on this link.

If you currently have a contract with MHS and need to add an additional practitioner

Go to our For Providers Tab.
Select Enrollments and Updates.
Select Add Provider to Existing Contract (Enroll a Contracted Provider).
Complete the Contracted Enrollment Request.
Attach the required documents.
The MHS Credentialing team will verify the required criteria and once verification is completed, the MHS data team will enroll the provider (Facility/Hospital) and/or practitioner (Physician/Group) in the requested networks.
Provider (Facility/Hospital) and/or practitioner (Physician/Group) will receive a unique identifier that will confirm receipt of the network participation request and can be used to check the status of all components of the network participation request. (Effective 1/1/2022)
Provider (Facility/Hospital) and/or practitioner (Physician/Group) will receive a welcome letter with their effective date or a detailed rejection notice

Please note that all incomplete network participation requests will be rejected, and notification will be sent within 5 business days after the receipt of the initial request if the required documents are not provided.

If you DO NOT have a contract with MHS or is unsure if you have a Contract with MHS:

Go to our For Providers Tab.
Select New Contract (Request a New Contract).
If you are unsure if you have a contract with MHS or want to know which networks you are currently contracted with, select I am unsure if I have an MHS contract.
- Complete the required fields and a representative will follow-up.
If you are a brand-new provider (Facility/Hospital) and/or practitioner (Physician/Group), select I do not have a contract and need to apply.
- Complete the Become a Contracted Provider, submit the required documents to complete a network participation request, and a Contract Negotiator will follow-up.
Provider (Facility/Hospital) and/or practitioner (Physician/Group) will receive a unique identifier that will confirm receipt of the network participation request and can be used to check the status of all components of the network participation request. (Effective 1/1/2022)
A Contract Negotiator will create a contract between MHS and the provider (Facility/Hospital) and or practitioner (Physician/Group).
Once there is mutual agreement and the contract is signed by both parties, the Contract Negotiator will submit the contract and their required documents to the Enrollment Team to be processed.
The Enrollment team will enroll the provider (Facility/Hospital) and/or practitioner (Physician/Group) in the requested networks.
Provider (Facility/Hospital) and/or practitioner (Physician/Group) will receive a welcome letter with their effective date or a detailed rejection notice.

Helpful Tips to Making Sure your Enrollments are Processed Successfully

Please ensure the following:

Your Provider (Facility/Hospital) and/or practitioner (Physician/Group) is enrolled with IHCP before the submission of enrollment or request to contract.
That all rendering practitioners associated with the group are tied to your group NPI and/or Tax Identification Number.
That all the required documents are up to date, complete, and accurate.
That your provider's (Facility/Hospital) and/or practitioner's (Physician/Group) taxonomy matches the enrollment form/or spreadsheet and IHCP.
The address the provider (Facility/Hospital) and/or practitioner (Physician/Group) is wanting to be added to matches the enrollment form/or spreadsheet and IHCP.
That the enrollment form is attached for all new enrollments.
That the requested primary address is linked to IHCP.
Behavioral Health Practitioners (Social Worker, Counselors, HSPP, Mental Health Therapist), ensure that you are set up with IHCP as a Group and your personal NPI is listed as a rendering practitioner.

In addition to the above:

MHS does not enroll Locum Tenem practitioners.

Practitioner (Physician/Group)

If you do not know the dimensions of your office space, please contact your building maintenance and they will be able to provide that information to you to complete the Provider Credentialing Application Disability Supplement Form.

If you are a practitioner (Physician/Group), please enroll as a Physician/Group. If you are an Ancillary or Hospital, please enroll as an Ancillary or Hospital.
If your practitioner (Physician/Group) is already enrolled under a location and you want to add an additional location with the same TIN and Group NPI, please select update on the IHCP MCE Practitioner Enrollment Form and not new enrollment.

Effective Date Policy: (Effective 1/1/2022)

A brand-new provider that is not part of an existing contract with MHS will be effective the first of the month following the contract execution. Contract execution is the date that MHS countersigns the first signature agreement received from the Provider. In order for the contract to be executed. the provider's complete network participation request must also be submitted electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
- If a provider and MHS cannot come to terms with a contract, the provider will not be effective with MHS.
A provider that is being added to an existing contract will be effective the first of the month following receipt of the network participation request from the provider. The network participation receipt date is the date MHS receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
- If a provider requires credentialing and is not able to be credentialed, the provider will not be effective with MHS.
MCEs are encouraged to use the standard out of network process for services rendered by providers prior to the effective date if needed for member access to care.
The MCE network effective date must also be after the IHCP effective date. Providers must be enrolled and effective with IHCP prior to being effective with MHS.
Notification from MHS will be sent to the original submitter of an incomplete network participation request within five (5) business days after receipt of initial request. An incomplete network participation request is a request that MHS cannot fully process because there is missing documentation, information needed to write a contract, etc.
Providers should hold all claims until the final welcome letter from MHS is received confirming that they are effective with the MHS network. Claims submitted prior to receipt of a welcome letter will not automatically be reprocessed and providers will need to submit a Medical Claim Dispute/Appeal Form to request reconsideration of the claim. MHS and providers are expected to complete all pieces of the network participation process timely. However, in instances where the network participation process extends for a time period longer than the standard timeframe, MHS will not hold providers to the timely filing limit for claims rendered before the provider was confirmed effective.
OMPP is allowing the MCEs flexibility to deny the provider participation request if the contracting phase cannot be completed in an acceptable timeframe that is no more than 60 days. This will allow the effective date policy to remain consistent but also hold all parties accountable for the turnaround of necessary items for the network participation process. It is important that the MCEs educate providers on the significant impact any delay in signing a contract will have and that if they do not meet the timeframe their request will be denied.
Exceptions to the effective date policy outlined may be granted by MHS in the following circumstances:
- When the retroactive date is in the best interest of member care.
- In situations involving changes of ownership, including provider mergers, acquisitions, or tax identification changes.
- In situations where a provider has a preexisting contractual relationship with an MCE and has sought a change in their provider enrollment type or classification with IHCP (i.e., when a provider was enrolled as a billing provider but has decided to enroll as a group provider).
- Upon request from providers in FQHCs or RHCs. The effective date cannot be prior to the date established by IHCP.
- The effective date policy does NOT affect delegated provider arrangements.

Proceed to Enroll Provider to Existing Contract - CNR

Proceed to Enroll Provider to Existing Contract - Medical or BH